Premier Dialysis of Ferguson

Primary specialty

End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X

Legal business name

PREMIER DIALYSIS OF FERGUSON

Practice address

800 Chambers Rd
Ferguson, MO 63135-2133

Phone

(314) 522-8100

Fax

(314) 524-7826

NPI assigned

Jan 29, 2007

Last updated

Dec 10, 2008By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Harold Goldammer Jr.

Title

President

Phone

(618) 407-2153

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1170028800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1228867200000",
    "number": "1750427548",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "132 FOX HILL CT",
            "city": "EDWARDSVILLE",
            "state": "IL",
            "postal_code": "620255736",
            "telephone_number": "618-407-2153"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 CHAMBERS RD",
            "city": "FERGUSON",
            "state": "MO",
            "postal_code": "631352133",
            "telephone_number": "314-522-8100",
            "fax_number": "314-524-7826"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIER DIALYSIS OF FERGUSON",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-29",
        "last_updated": "2008-12-10",
        "status": "A",
        "authorized_official_last_name": "GOLDAMMER",
        "authorized_official_first_name": "HAROLD",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "618-407-2153",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "504605403",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Ferguson, MO
• Providers in Ferguson, MO by specialty
• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.